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Pap Smear
by Kate Lee

What's a Pap smear?

A Pap smear is a test used to detect cells that might develop into cancer of the cervix, the part of the uterus that connects to the vagina. The test also turns up infections and other abnormal cervical cells.

Since its introduction in the 1940s by George Papanicolaou (for whom it's named), the Pap smear has become the most successful cancer screening tool ever invented. This simple test has cut cancer deaths among women by 70 percent.

How often should I have one?

You should have Pap smears routinely from the time you're first sexually active (or from the age of 18, whichever comes first) to the end of menopause. Many experts recommend that you be tested every year, although if the results regularly come back negative your doctor may suggest longer intervals between screenings.

If you meet any of the following criteria, you should have an annual Pap smear:

  • You've had multiple sexual partners or a male partner who has had multiple sexual partners.
  • You first had intercourse before age 18.
  • You have had a male sexual partner whose previous partners included someone with cervical cancer.
  • You have a history of genital herpes infection or genital warts caused by the human papilloma virus.
  • You're HIV-positive.
  • You smoke.
  • Your immune system is below par (as a result of recent transplant surgery, for example).
  • You have a history of abnormal Pap smears.
  • You've had cervical, uterine, vaginal, or vulvar cancer.
There's no hard-and-fast requirement that you be tested, but a Pap smear is a precaution that saves the lives of thousands of women in the United States each year.

Insurance companies often pay for it as a standard part of an annual pelvic exam. If you don't have insurance, or if your insurance covers only one test every three years, call a local women's clinic or a city health clinic. Many offer Pap smears for free.

How do I prepare for a Pap smear?

It's best to have one when you're not menstruating. Don't douche and don't use a spermicide or any vaginal medication or lubrication for two or three days before the test.

What happens during the procedure?

It's very simple. The doctor or nurse will ask you to lie on your back and place your feet in foot stirrups, which are often padded for comfort. Next he or she will use an instrument called a speculum to push the walls of your vagina slightly apart and hold them open during the exam (many doctors now warm their speculums so they won't feel cold to the touch).

Using a tiny brush or spatula, he or she will remove some cells from the surface of your cervix. This sample is smeared onto a glass slide, sprayed with a fixing chemical, and sent to a laboratory for examination.

Who checks my Pap smear?

Trained lab workers put your sample under a microscope and examine it for abnormal cells. Then they give it a classification and return it to your doctor, who contacts you to let you know the results. These are generally available within 10 to 14 days.

Some physicians get in touch only if an abnormality shows up, but if you don't hear from your doctor, call and ask for your results. That way a suspicious finding won't go unnoticed.

What does my Pap-smear classification mean?

Doctors have classified Pap smears differently over the years, causing much confusion. Many gynecologists now prefer to break all Pap-smear results down like this:

  • Normal or a subset of normal, such as "irritation" or "signs of infection"
  • Probably normal, but showing mild changes that should be checked on regularly or require further tests
  • Precancerous changes
  • Superficial or early cancer
  • Invasive cancer
All screening tools carry the possibility of error, and Pap smears are no exception. Sometimes a lab may classify a Pap smear as normal even if it contains abnormal cells (this is known as a false negative) or as abnormal even when the cervix is perfectly okay (this is known as a false positive).

Both are rare; fewer than 1 percent of Pap smears turn out to be false negatives. Annual gynecological exams that include Pap smears are the best way to guard against a false negative.

What if my sample isn't normal?

Don't panic. Even though it can be frightening to hear that your Pap smear has been judged abnormal, you're not likely to have cancer. An abnormal result usually means that there's a minor problem with the cervix, one that may not even need treatment.

You'll probably be asked to go back for either a second Pap smear or further exams. Sometimes a smear is classified as abnormal only because the lab worker had problems reading the sample.

If your Pap-smear results show that a few cells are abnormal, you have what's known as mild cervical dysplasia, which is considered a precancerous condition. ("Plasia" means growth, and the term "dysplasia" means that some cells aren't growing normally.) This is easy to treat, and cancer can almost always be prevented.

In severe dysplasia, part of the cervix's surface is covered with abnormal cells - but only the surface. This form of dysplasia will need to be dealt with immediately so that it doesn't develop into cancer.

In any event, an abnormal Pap-smear doesn't have to be bad news. In fact, British researchers analyzed the medical records of almost 350,000 women over 20 years and found that at least 80 percent of those with abnormal cervical cells never went on to develop cancer. In the rare cases in which invasive cancer is found, there are a variety of treatment options, including radiation.

-- Kate Lee is a former associate editor at Consumer Health Interactive and researcher at Time Inc. Health. She is currently a senior editor at BabyCenter.

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